Respiratory syncytial virus (RSV), a non-segmented, negative-strand RNA virus in the pneumovirus subfamily of Paramyxoviridae, is a widespread human pathogen accounting for over 1 million deaths per year worldwide (McIntosh and Chanock 1990). While the majority of serious cases are children from developing countries, there are estimated to be 300,000 hospitalized cases per year in the United States (Zisson, 1993). It is also believed that of childhood deaths from pneumonia caused by respiratory viral infections, 62% are due to RSV (Heilman, 1994). The only approved treatment for RSV is aerosolized ribavirin (1-b-D-ribofuranosyl-1,2,3-triazole-3-carboxamide). Ribavirin is administered as an aerosol which is inhaled. Ribavirin therapy has several limitations including minimal efficacy in clinical use, the requirement of a tent around the patient, the potential to clog ventilating units, and the observation of some teratogenicity in animal models (Froelich, 1994), significant side effects and high cost.
RSV replicates in several alveolar cell types including macrophage and epithelial lineages (Panuska et al., 1992, Midulla et al., 1993). Accordingly, ribavirin is administered to RSV infected individuals by inhalation of an aerosol. Taber et al., 1983, Pediatrics 72:613-18; Hall et al., 1983, N. Eng. J. Med. 308:1443-7; Englund et al., 1994, J. Pediatrics 125:635-41.
Activator-antisense complexes (termed therein "2-5A:AS") have been described previously (Torrence et al., 1993, WO 94/09129 by Torrence et al.). Although antisense oligonucleotides have been used as antiviral agents, e.g.: to inhibit HIV replication, see Zamecnik et al, 1986; Goodchild et al., 1988; Letsinger et al., 1989; Balotta et al., 1993; to inhibit RSV infection, WO95/22553 by Kilkuskie et al., no examples of the successful use of activator-antisense complexes as an antiviral therapy have been reported.
The mechanism of action of activator-antisense complexes is different than the mechanism of action of other antisense oligonucleotides. The activator portion of the activator-antisense complexes activates RNase L and the antisense domain serves as a specific, high affinity binding site for the target RNA. The result is the selective cleavage of the target RNA by RNase L.
Physiologically, RNase L functions as part of the interferon system in restricting virus replication in cells of higher vertebrates (reviewed in Silverman, 1994). Interferon treatment of cells activates genes encoding 2-5A synthetases, double-stranded RNA (dsRNA)-dependent enzymes that produce 5'-triphosphorylated, 2',5'-linked oligoadenylates (2',5'A) from ATP. Viral dsRNAs are potential activators of these enzymes (Gribaudo et al., 1991). The 2',5'A binds to and activates RNase L resulting in the general cleavage of cellular and viral RNA; thus restricting the replication of some picornaviruses (Chebath et al., 1987; Rysiecki et al., 1989; and Hassel et al., 1994).
RNase L is not specific for cleaving viral RNA. For instance, in interferon-treated, encephalomyocarditis virus infected cells, RNase L causes degradation of ribosomal RNA (Wreschner et al., 1981). Through the activator-antisense approach, RNase L is converted from a non-specific nuclease to a highly specific endoribonuclease that selectively cleaves mRNA targets. This has been demonstrated in a cell-free system from Daudi cells, a human lymphoblastoid cell line, in which a modified HIV-1 vif mRNA was targeted for cleavage by an activator-antisense complex (Torrence et al., 1993). Subsequently, purified RNase L has been directed by an activator-antisense complex to cleave selectively an mRNA target encoding the protein kinase PKR in the presence of a nontargeted mRNA (Maran et al., 1994). Furthermore, in HeLa cells, the use of activator-antisense complexes, which were directed to a sequence in PKR mRNA, resulted in the ablation of PKR mRNA and enzyme activity (Maran et al., 1994) such that the dsRNA-mediated activation of transcription factor, NF-kB was ablated. More recently, it was shown that the activation of RNase L by an activator-antisense complex results in the catalytic degradation of PKR mRNA (k.sub.cat, of about 7 sec.sup.-1) (Maitra et al., 1995).